Anthem limits number hospitals in NH from which insurance exchange members can seek care

Starting Jan. 1, Southern New Hampshire Regional Medical Center and 11 other hospitals will not serve patients who get individual health insurance through exchanges under the Affordable Care Act, officials with Anthem Blue Cross and Blue Shield confirmed Wednesday.

Critics quickly said this change will force residents in Concord, the Seacoast and the North Country to travel farther to get to a hospital or their own doctor’s office.

Anthem will use this “narrower network” for all customers with individual insurance whether they are in or out of the exchange also known as the marketplace, Anthem lobbyist Paula Rogers told the Joint Health Care Reform Oversight committee.

“We are working towards a focused and narrower network,” Rogers said. “We’ve got 26 hospitals. Do we need 26 hospitals to serve the population we expect to see and still provide quality of care? We decided that we didn’t.”

This change affects not only hospital care but doctor visits since many primary care physician practices across the state are hospital-owned.

Southern New Hampshire Medical executives recently learned they were not in this new network when they confirmed that St. Joseph Hospital of Nashua was, said Scott Westover, vice president for strategic management at SNHMC.

“Anthem made the decision about the marketplace without a conversation with us,” Westover said.

This decision by Anthem can be changed in future years and Harvard Community Health Plan officials have said they intend to offer coverage to those in the exchange in 2015.

“We look at the exchange in the early days as an experiment,” Westover said. “In my mind, the opportunity to continue the conversation with Anthem or any other company remains open-ended, and as we go forward, I am sure there will be opportunities with multiple, insurance payers as well.’’

Senate Majority Leader Jeb Bradley, R-Wolfeboro, said it was frustrating state Insurance officials recommended Anthem’s proposal to federal officials July 27 but still has not spoken publicly about the details because agency rules require all insurance plans are confidential until their effective date.

“It is astounding to me. We are going to be introducing rationing of health care in New Hampshire, and we aren’t talking about it,” Bradley said.

State Rep. John Hunt, R-Rindge, said he considers it ironic the Affordable Care Act was sold to the American people as not disrupting anyone with insurance, yet that’s just what this Anthem plan will do.

“We aren’t going to be able to go to the doctor of our choice, the hospital of our choice or the plan of our choice,” Hunt said.

The federally run exchange, or marketplace, is designed to be the clearinghouse, or safety net, for those without insurance to get it – the middle class, the under-employed as well as the young and well-off who don’t bother buying it.

Starting Jan. 1, all individuals must buy coverage or pay roughly a $100 annual fine to the Internal Revenue Service.

Some insurance analysts believe, once fully implemented, the marketplace could cover as many as 150,000 people in the state.

The Affordable Care Act offers for those in the marketplace tax credits for health care insurance expenses for families who earn up to 400 percent of the federal poverty level or $94,200 for a family of four.

Supporters of the Affordable Care Act insist the exchange will produce a large and diverse enough pool of individuals and employees of small businesses that Anthem – the only one to offer this coverage in New Hampshire – can price it low enough to attract customers.

This change for Anthem also affects any small-business owner who after Jan. 1 decides to purchase coverage for their employees through what’s known as the shop exchange run by the federal government.

Analysts expect few small-business owners will pursue this option because federal law doesn’t require them until Jan. 1, 2015, to certify that all their employees have some type of coverage.

“That’s not our focus,” Rogers said.

Anthem’s stated goal with this narrow network is to reduce what these preferred hospitals and affiliate doctors charge them for care.

In return, the chosen hospitals and doctors become exclusive providers for individual insurance, and those plans typically are the most expensive for consumers, Rogers said.

“There will be some abrasiveness. People will have to choose new PCPs,” said Maria Proulx, senior legal counsel for Anthem in New Hampshire.

The only ones exempt from this new policy are those who bought individual insurance through Anthem since 2010 when Congress approved the Affordable Care Act.

Furthermore, anyone needing to receive care at an emergency room will be brought to the closest hospital whether it’s in this exchange network or not, Proulx said.

Commerce Committee Chairman Ed Butler, D-Hart’s Location, stressed that the Affordable Care Act marketplace will offer insurance to those who can’t get it with broader coverage and for those who now receive it in the individual market.

“We are going to be providing coverage for as many people as possible, and that’s a major, positive development,” Butler said.

Sen. Peggy Gilmour, D-Hollis, said this is a return to nearly 40 years ago when health maintenance organizations burst on the scene, which restricted patient choice.

“We have lived through narrowing of networks in the past,” Gilmour said.

New Hampshire Hospital Association President Steve Ahnen said his group has concerns whether this narrower network is the best approach for patients.

“Does this limited network provide that opportunity or are there holes that will impact our patients? Again, the question needs to be, ‘Are we getting the patient the right care at the right place and at the right time?’ “ Ahnen said. “Does this hinder that?”

Sen. Andy Sanborn, R-Bedford, faulted Gov. Maggie Hassan’s administration for permitting this controversy to remain silent for months while open enrollment for those in these exchanges begins Oct. 1.

“It is troublesome that the executive branch knew about these network reductions back in July and, despite what they would mean to patients, still saw fit to approve these contracts,” Sanborn said. “And now, they are declining to answer important, fundamental questions about what they will mean for the citizens of New Hampshire.”

Hassan’s spokesman noted the GOP-led Legislature passed a state law in 2012 blocking the state from running its own exchange, and the federally run alternative leaves consumers here with less information and government oversight.

“Questions have been raised about Anthem’s products to be offered within the health benefit marketplace, and while not required to release proprietary information under law at this time, the governor believes Anthem should quickly move to openly and transparently provide as much information as possible about their proposed network, as well as the cost of the insurance products they intend to provide in the marketplace,” Hassan spokesman Marc Goldberg said in a statement.

Anthem officials said within the next two weeks the Obama administration should approve its plan for the exchange. At that point, Proulx said it would release details to the public about what these plans will cost consumers.

In response, House and Senate leaders on the health care oversight panel agreed to set Oct. 2 as its next meeting.